Nepali-speaking LEP diabetes patients had the highest medication Adherence Ratio

Description #

Among 59 primary-care patients with type 2 diabetes, the Nepali-speaking LEP group (ethnically Bhutanese former refugees) was the most adherent overall by Adherence Ratio, while the Latin(x) English-preference group was the least adherent — contrary to the authors' hypothesis. After adjustment, Adherence Ratios for Nepali- vs English-preference patients were higher across medications (e.g., metformin 0.741 vs 0.601; ACE inhibitors 0.914 vs 0.511) (Table 2).

"The most adherent group overall (highest Adherence Ratio) were the Nepali-speaking patients, but the results showed high variability across outcomes and medications." (Kahler, 2022, p. 31)

"Surprisingly, the patients who were least compliant with their medication regimen were the Latin(x) English-preference patients." (Kahler, 2022, p. 33)

Methods Context #

What? #ⓘ

The observable: medication Adherence Ratio (actual days adherent ÷ expected days adherent), plus Actual Days of Medication Adherence and Maximum Days Non-Adherent, for diabetes medications (regular insulin, NPH insulin, metformin, ACE inhibitors).

"The outcome of interest was Actual Days of Medication Adherence, Adherence Ratio, and Maximum Days Non-Adherent." (Kahler, 2022, p. 32)

How? #ⓘ

Retrospective chart review of pharmacy-acquired medication profiles (refill data) over six months, annualized to 180 days; one-way ANOVA across language groups and ordinary least squares regression with self-reported preferred language as the independent variable, adjusted for confounders.

"Data collection for this observational study was accomplished through chart review of patient medical records at the Family Medicine clinic of the University of Kansas Health System." (Kahler, 2022, p. 31)

Who? #ⓘ

59 established Family Medicine primary-care patients with type 2 diabetes (HbA1c ≥ 8%), preferred language English (n=15), Spanish (n=21), or Nepali (n=23); Nepali speakers were ethnically Bhutanese former refugees served by a single bilingual physician.

"Participants in the study were selected via electronic medical record (EMR) chart review to meet the following qualifications: preferred language as Nepali, Spanish, or English; at least 18 years old; diagnosis of T2DM prior to study enrollment; and a hemoglobin A1c (HbA1c) of at least 8%." (Kahler, 2022, p. 31)

Other Notes #

Despite higher adherence, the Nepali group had a higher mean HbA1c [10.6 (2.0 SD)] than the Spanish group [9.8 (1.6 SD)], suggesting adherence did not translate directly into glycemic control.

Caveats #

• Pharmacy-refill Adherence Ratio does not capture whether medication was actually taken correctly Adherence was measured indirectly from pharmacy refill data (the Adherence Ratio), a surrogate chosen because no validated direct metric was available. This captures whether medication was obtained, not whether it was actually taken correctly — a construct-validity gap. The authors also note patients may have filled prescriptions at unlisted pharmacies, undercounting fills.